Medigap-guaranteed issue associated with Medicare Advantage disenrollment for beneficiaries administered a part B drug.

Health affairs scholar Pub Date : 2024-10-23 eCollection Date: 2024-11-01 DOI:10.1093/haschl/qxae136
Angela Liu, David Pittman, Gerard Anderson, Jianhui Xu
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Abstract

While many Medicare beneficiaries are enrolling in Medicare Advantage (MA), some beneficiaries may want to return to traditional Medicare and purchase Medigap, especially beneficiaries who have greater medical needs. Beyond minimal federal regulations, states impose additional regulations that impact Medigap affordability. Beneficiaries in some states have greater difficulty obtaining Medigap coverage because the states where they live allow Medigap insurers to experience rate the beneficiary, which can make Medigap insurance prohibitively expensive. We examined beneficiaries who received physician-administered drugs, which can be expensive and subject to high cost sharing, to see if disenrollment from MA for these beneficiaries was greater in states with Medigap consumer protection policy levels. In 2020, we find a 1.0% average baseline average probability of MA disenrollment. For beneficiaries who received a physician-administered drug in our sample, the probability of MA disenrollment is 3.7 (95% CI, 2.6-4.8; P < .001) percentage points higher in Medigap-guaranteed issue states compared with states with no protections. We find a greater association between MA disenrollment and Medigap protection policies with higher cost drugs. These findings suggest that beneficiaries who receive a high-volume and high-spending physician-administered drug are more likely to disenroll from MA back to traditional Medicare when Medigap is more affordable.

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与 B 部分药物受益人退出 Medicare Advantage 相关的 Medigap 保证问题。
虽然许多联邦医疗保险受益人都加入了联邦医疗保险优势计划(MA),但有些受益人可能希望回到传统的联邦医疗保险并购买 Medigap,尤其是有更多医疗需求的受益人。除了最低限度的联邦法规外,各州还规定了影响 Medigap 可负担性的额外法规。有些州的受益人更难获得 Medigap 保险,因为他们居住的州允许 Medigap 保险公司向受益人收取经验费率,这可能会使 Medigap 保险费用过高。我们对接受医生管理药物的受益人进行了调查,这些药物可能价格昂贵,分担的费用也很高,以了解在 Medigap 消费者保护政策水平较高的州,这些受益人退出 MA 的情况是否更多。2020 年,我们发现医疗保险退出的平均基线概率为 1.0%。对于我们的样本中接受医生管理药物的受益人而言,与没有任何保护措施的州相比,在有 Medigap 保证发行的州中,医疗保险退保的概率要高出 3.7 个百分点(95% CI,2.6-4.8;P < .001)。我们发现,医疗保险退保与 Medigap 保障政策中药物费用较高之间存在较大关联。这些研究结果表明,当 Medigap 更实惠时,接受高用量和高支出医生管理药物的受益人更有可能从医疗保险退保回到传统的医疗保险。
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